Birabwa Catherine, Amongin Dinah, Waiswa Peter, Phillips Beth, Wasswa Ronald, Suchman Lauren, Sedlander Erica, Holt Kelsey, Atuyambe Lynn
Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
Global Public Health, Karolinska Institute, Stockholm, Sweden.
BMC Public Health. 2025 Jul 2;25(1):2286. doi: 10.1186/s12889-025-23473-x.
Women in sub-Saharan Africa often lack agency to make their own contraceptive decisions, more so in rural settings. Evidence indicates that social networks influence contraceptive decision-making and behaviours but there is limited information on the dynamics between women and their network members. We explored ways in which women's social networks influenced their agency to make contraceptive decisions.
We conducted an exploratory qualitative study, between February and May 2021, among 60 women (15-45 years) from two largely rural districts in Uganda. Data were collected using semi-structured audio-recorded in-depth interviews which were transcribed verbatim. We used thematic analysis guided by constructs from social network mechanisms to analyze the data.
Half of the participants were adolescents (15-19 years) and 62% (37/60) were current contraception users. We found that participants most commonly involved partners, relatives, and peers in their contraceptive decision-making. Social support emerged as the most common mechanism through which these network members influenced women's agency in making and acting on their contraceptive decisions. This was mainly in the form of informational and emotional support. Informational support, mostly provided by relatives and peers, included advice to adopt contraception particularly given to participants who desired to better manage their families, describing lived experiences, directing women to formal contraceptive services, and sharing perceived/actual side effects of contraceptive use. Emotional support, provided by partners and relatives, involved acknowledging and validating decisions, as well as providing reassurance regarding contraceptive experiences. Some women also received instrumental support (reminders to get dose/method and exempting women from responsibilities to go seek contraceptive services). The mechanism of social influence was also at play with social pressure to give birth.
Our study highlights how different types of social support from partners, relatives, and peers can either bolster or undermine women's agency in making contraceptive decisions. Informational support from relatives and peers can boost women's certainty in their intentions, while emotional support from partners boosts their confidence to act on these intentions. Multipronged approaches targeting these networks are necessary to promote women's agency in making contraceptive decisions.
撒哈拉以南非洲地区的女性往往缺乏自主做出避孕决定的能力，农村地区的情况更是如此。有证据表明，社会网络会影响避孕决策和行为，但关于女性与其网络成员之间动态关系的信息有限。我们探讨了女性的社会网络影响其做出避孕决定的能力的方式。
2021年2月至5月，我们在乌干达两个主要为农村地区的60名15至45岁女性中进行了一项探索性定性研究。数据通过半结构化录音深入访谈收集，并逐字转录。我们使用以社会网络机制构建为指导的主题分析来分析数据。
一半的参与者为青少年（15至19岁），62%（37/60）为当前的避孕使用者。我们发现，参与者在避孕决策中最常涉及伴侣、亲属和同龄人。社会支持是这些网络成员影响女性做出和实施避孕决定的能力的最常见机制。这主要表现为信息支持和情感支持。信息支持大多由亲属和同龄人提供，包括建议采用避孕措施，特别是给那些希望更好地管理家庭的参与者，描述生活经历，引导女性前往正规避孕服务机构，以及分享避孕使用的感知/实际副作用。情感支持由伴侣和亲属提供，包括认可和确认决定，以及就避孕经历提供安慰。一些女性还得到了工具性支持（提醒服药/采用避孕方法以及免除女性寻求避孕服务的责任）。社会影响机制在生育的社会压力方面也发挥了作用。
我们的研究强调了来自伴侣、亲属和同龄人的不同类型的社会支持如何既能增强也能削弱女性做出避孕决定的能力。亲属和同龄人的信息支持可以增强女性对自己意图的确定性，而伴侣的情感支持则增强她们按照这些意图行动的信心。针对这些网络采取多管齐下的方法对于促进女性做出避孕决定的能力是必要的。
